Stages of Alcoholism

During the early stages of alcoholism, it can be hard to tell that someone even has a drinking problem. But as the disease progresses, it follows a treacherous path of destruction and misery. By the time they reach the end stage of the disease, alcoholics are shadows of their former selves with potentially fatal health problems.
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No one chooses to become an alcoholic. But some people who drink face a risk of developing this chronic and progressive disease, which affects roughly 1 in every 8 Americans and contributes to about 88,000 deaths annually.

While every person’s alcohol addiction is unique, alcohol affects people in similar ways. Most people with an alcohol use disorder progress through three typical stages.

In the beginning stages of alcoholism, drinking escalates and the individual develops an increased tolerance for alcohol. Those biological changes pave the way for the second stage, which is marked by a physical dependence on the drug. Drinking at this point isn’t about feeling good — it’s about not feeling bad and avoiding the uncomfortable sensations that accompany acute withdrawal.

By the time they’ve reached the third and final stage of alcoholism, drinking has consumed their lives. Their alcohol withdrawal symptoms are so severe that they must drink continually to avoid them.

The mental and physical health of alcoholics are rapidly deteriorating at this stage, and unless they seek alcohol rehab, they may drink themselves to death.

Early-Stage Alcoholism

The early or adaptive stage of alcoholism marks the beginning of an alcoholic’s struggle with addiction. At this point, drinking is no longer just a casual social activity — it’s become a daily habit that may be used to cope with stress, anxiety or other emotional problems.

Other than the fact that someone is drinking more than usual, it might be hard to detect that there’s even a problem because outwardly the alcoholic appears normal. Internally, though, significant biological changes are occurring.

As alcohol consumption increases, the liver adapts to break down alcohol more quickly. Over time, repeated alcohol exposure also alters a person’s brain chemistry. To counteract the sedating effects of alcohol, for example, the brain increases the activity of excitatory neurotransmitters, which speed up brain activity.

Alcoholism affects roughly 1 in every 8 Americans.

These physiological changes contribute to the increasing tolerance seen in early-stage alcoholics. Despite heavy alcohol consumption, they may show few signs of intoxication or ill effects from drinking, such as a hangover. And as tolerance builds, they’ll begin to drink more and more to achieve the same buzz or high they’re used to.

At this stage, the alcoholic may appear to be functioning normally and is unlikely to have performance problems at work, school or in other settings. In fact, they may mistakenly believe that drinking actually helps them to function better.

Even though alcohol has become a significant part of everyday life, early-stage alcoholics often deny that they have a problem and may be defensive about their drinking. They may also rationalize, or make excuses, for their behavior and insist they can stop drinking whenever they feel like it.

Middle-Stage Alcoholism

As the disease progresses to the middle stage, drinking continues to increase and dependency develops. Strong cravings for alcohol are typical at this stage, and drinking isn’t just for enjoyment anymore. Because the body has adapted to deal with an alcohol-rich environment, the alcoholic physically needs it to avoid the painful symptoms of withdrawal.

When alcohol is not present, individuals may experience uncomfortable symptoms such as restlessness, tremors, headache, nausea, vomiting and insomnia. These symptoms can occur six to 24 hours after their last drink.

Alcoholics in this stage have a hard time controlling their drinking. They may begin drinking early in the day and plan their day around their drinking. In social situations, they may be unable to stop drinking when others do and find that they can’t handle as much as they previously could without becoming drunk. Blackout episodes, where the individual does not remember what they’ve said or done while drinking, may occur. They may also drink in secret and lie about their drinking.

Despite efforts to hide their addiction, their drinking problem is quite obvious to others. Work performance usually suffers at this stage, and impairment in the workplace is common. Personal relationships are unraveling as well. Middle-stage alcoholics may become irritable or angry if confronted about their drinking. Mood swings, depression and feelings of guilt and shame are common.

By this stage, their drinking is taking an obvious physical toll as well. They may appear red in the face or look bloated and generally unwell. The alcoholic probably isn’t sleeping or eating well at this point and may not be keeping up with personal hygiene.

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End-Stage Alcoholism

Those in the end stage of alcoholism, or late or deteriorative stage, are consumed by their drinking. Years of chronic alcohol consumption have ravaged their body and mind, and their lives revolve around little else other than the bottle.

Drinking continues around the clock. Stopping is impossible at this point without professional help because of the severe and potentially life-threatening withdrawal symptoms that would occur if they quit cold turkey.

It’s common at this point for alcoholics to have lost their jobs as well their friends and family. Some, but not all, late-stage alcoholics end up homeless.

The end-stage alcoholic suffers from a host of physical problems, including severe damage to vital organs such as the liver. Alcohol, in fact, is the cause of more than 50 percent of liver-disease related deaths in this country, and alcohol-related liver disease costs more than $3 billion annually.

Alcoholic Liver Diseases

Between 90 and 100 percent of alcoholics develop a fatty liver, which can progress to cirrhosis. Up to 35 percent of alcoholics develop liver inflammation known as alcoholic hepatitis, and 8 to 20 percent will develop cirrhosis, a severe scarring of the liver that hinders the organ’s ability to function normally. The condition eventually leads to liver failure.

In its early stages, cirrhosis often has no symptoms. Later, it can cause fatigue, bleeding and bruising, itchy skin, yellow discoloration of the skin and eyes and fluid accumulation in the abdomen known as ascites. Fluid buildup in end-stage liver disease is a particularly ominous sign. Fifty percent of patients with ascites typically die within two years if they don’t have a liver transplant.

Alcoholism contributes to about 88,000 deaths annually in the US.

Cirrhosis can cause a host of other health problems, including high blood pressure, which can lead to the development of enlarged veins in the esophagus called esophageal varices. These are similar to the varicose veins that some people develop in their legs. But esophageal varices are prone to rupture, and when they do, the alcoholic can bleed to death.

Other health conditions commonly associated with late-stage alcoholism include malnutrition, chronic pancreatitis, Barrett’s esophagus and esophageal cancer, lung infections and heart failure. Because of the toxic effects alcohol has on bone marrow, blood disorders such as anemia are common in alcoholics.

Alcoholism can also cause significant brain damage. Some chronic alcoholics develop a condition called Wernicke-Korsakoff syndrome, which results from a thiamine (vitamin B-1) deficiency. The condition, which is sometimes called wet brain, is characterized by eye movement disorders, loss of muscle coordination, confusion and memory issues. It affects more men than women and is fatal 10 to 20 percent of the time.

End-stage alcoholics are also at a high risk of dying from accidents, trauma and suicide.

Recovery Is Possible

While end-stage alcoholism is a dire situation, it’s not a hopeless one. Late-stage alcoholics can get better if they seek treatment, and some of their health problems can even be reversed if caught early enough.

Because of the severity of the disease, medically monitored alcohol detox is a necessity. Between 3 and 5 percent of people withdrawing from alcohol develop grand mal seizures and severe confusion, known as delirium tremens. Delirium tremens symptoms typically begins about three days after other withdrawal symptoms start. It usually lasts for between two and three days, and it can be fatal.

Once detox is complete, alcoholics can begin tackling problematic behaviors related to their addiction and learn how to live sober again. Because alcoholism is a chronic disease and alcohol relapse is common, persistence is a necessity — but success is achievable.

Approximately one-third of alcoholics who enter treatment are symptom-free a year later, according to the National Institutes of Health, and many others have “substantially reduced their drinking and report fewer alcohol-related problems.”

You don’t need to wait until the brink of disaster to seek help. No matter the stage of the disease, if you or someone you love is struggling with alcohol addiction, seek professional help to achieve the benefits of quitting alcohol and learn how to live a healthier life.

Author
Amy Keller, RN, BSN
Content Writer, DrugRehab.com
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.
@DrugRehabAmy
Editor
Joey Rosenberg
Joey Rosenberg,
Editor, DrugRehab.com
Medical Reviewer
Ashraf Ali
Psychiatrist, Los Angeles County Department of Mental Health

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